De Maio F, Caterini A, Cesaretti L, Ziranu A, De Luna V, Farsetti P
Department of Clinical Science and Translational Medicine, Section of Orthopedics and Traumatology, University of Rome "Tor Vergata", Italy.
Eur Rev Med Pharmacol Sci. 2022 Nov;26(1 Suppl):1-8. doi: 10.26355/eurrev_202211_30275.
Periprosthetic femoral fractures (PFF) are a serious complication in patients who have undergone hip arthroplasty. Some authors consider revision arthroplasty as the gold standard in the surgical treatment of Vancouver type B2 and B3 PFF. Others, however, prefer treating PFF by open reduction and internal fixation (ORIF), without revising loose stems, especially in elderly patients. In the present retrospective study, we report mid/long-term results in a series of patients affected by B2 or B3 PFF surgically treated by ORIF, using a locking compression plate (LCP), thus avoiding the need of revision arthroplasty.
We reviewed 28 patients affected by B2 or B3 PFF surgically treated between 2010 and 2017 by ORIF using a LCP, after an average follow-up of 5.5 years. The average age of the patients at diagnosis was 78 years; in 17 patients, the femoral stem was uncemented while in 11, cemented. The mean interval time between hip arthroplasty and PFF was 6.7 years. Clinical results were assessed using Harris Hip Score (HHS), while radiographic results according to Beals and Tower criteria.
At follow-up, HHS ranged from 72 to 96 points; 8 patients had an excellent result, 12 got a good result and 8 a fair result. According to Beals and Tower criteria, all the radiographic results were excellent (9 patients) or good (19 patients). The majority of our patients returned to their previous ambulatory levels.
According to our results, in elderly patients affected by Vancouver type B2 or B3 PFF, surgical treatment by ORIF using a locking compression plate, without a stem revision, seems to be associated with satisfactory outcome.
人工关节周围股骨骨折（PFF）是髋关节置换术后患者的一种严重并发症。一些作者认为翻修关节成形术是温哥华B2型和B3型PFF手术治疗的金标准。然而，另一些人则倾向于通过切开复位内固定术（ORIF）治疗PFF，而不翻修松动的股骨柄，尤其是在老年患者中。在本回顾性研究中，我们报告了一系列采用锁定加压钢板（LCP）通过ORIF手术治疗的B2或B3型PFF患者的中长期结果，从而避免了翻修关节成形术的需要。
我们回顾了2010年至2017年间通过ORIF使用LCP手术治疗的28例B2或B3型PFF患者，平均随访5.5年。患者诊断时的平均年龄为78岁；17例患者的股骨柄为非骨水泥型，11例为骨水泥型。髋关节置换术与PFF之间的平均间隔时间为6.7年。使用Harris髋关节评分（HHS）评估临床结果，而根据Beals和Tower标准评估影像学结果。
随访时，HHS评分范围为72至96分；8例患者结果优秀，12例良好，8例一般。根据Beals和Tower标准，所有影像学结果均为优秀（9例）或良好（19例）。我们的大多数患者恢复到了之前的活动水平。
根据我们的结果，对于受温哥华B2或B3型PFF影响的老年患者，使用锁定加压钢板通过ORIF进行手术治疗，不进行股骨柄翻修，似乎能带来满意的结果。
